A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 2)

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

As noted previously, Glantz differs from some e-cigarette “pessimists” in his sociopathic willingness to repeat obvious lies. Most notably, there is a huge amount of evidence about switching. More subtly, there is no basis for claiming most people who vape are also still smoking. We know that most smokers who have tried an e-cigarette are still smoking, contrary to the “they are a miracle” view, but we have relatively little information on how many e-cigarette users (by any normal interpretation of the term — i.e., not merely someone who has tried one or takes a puff on one periodically) still smoke. The spotty evidence that exists suggests that most who have become regular e-cigarette users have become non-smokers or have moved far in that direction.

As a minor aside, it is worth noting that in some places, the verb “smoke” is used to refer to vaping an e-cigarette, but in the USA it tends to only show up when the author only did five minutes of research before claiming expertise on the topic (e.g., most local news reporters) or by someone who thinks that smoking is evil and wants to extend that to vaping. Though it is not presented as a direct quotation, this paragraph appears reflect Glantz being in the latter category.

The last sentence is an out-and-out confession that tobacco control, and “public health” in general, is not about helping people, but about demanding obedience and intentionally hurting people if they are not obedient. Basically it says, “we intentionally harm smokers, such as by limiting where they can smoke, for the purpose of lowering their quality of life so much that they are better off obeying our diktats. E-cigarettes offer a way to relieve some of the imposed suffering, and we can’t have that.” Of course, the same can be said about NRT, but is not.

That sentence, and the paragraph in general, illustrate a point about those who accept or even embrace e-cigarettes, but are still part of “public health” or the medical industry rather than really believing in the principles of harm reduction: Glantz tells these lies because if they were true, his fellow “public health” people would conclude that e-cigarettes are bad. But a real supporter of harm reduction — and indeed, any decent human being who actually cared about people — would still conclude e-cigarettes are good. Even if the all lies were true, it would still be the case that some smokers are freely choosing to switch completely to e-cigarettes (good); some smokers, who now can choose to smoke, vape, neither, or both, find that “both” is the choice that is best for them (also good — those making that choice must like it better than just smoking); almost all of those choosing “both” are smoking less (good for their health); and the harm suffered by smokers from not being able to smoke in certain circumstances is also reduced (good, assuming you actually care about people).

Harm reduction inevitably increases total consumption; lower the cost of something and more people will consume it. For THR, this primarily means that as low-risk tobacco products are developed and people understand them, there will be more total tobacco users. Some people who would have been abstinent from all tobacco in a world without e-cigarettes — including some who would have never smoked at all — will decide to become vapers. But in the weird world of tobacco politics, this has an unusual implication: One of the harms suffered by smokers is having to go outside for a smoke, and smoke-free alternatives reduce that harm too. The inevitable result of harm reduction, then, means that since smoke-free alternatives lower the cost of smoking a bit, they will cause some smoking that would not have otherwise occurred (albeit, probably very little).

In the “debates” that you see in the newspaper, almost everyone represented is of the opinion that this outcome is wholly bad, differing only in what they think (or pretend to think) about how this cost compares to the benefits. The opinions that are allowed into the public debate cover the spectrum of views from A (abject hatred of all tobacco products and users, and a fantasy belief they can both be eliminated) through about P (reluctant acceptance that people will use tobacco and a belief that it is not too terrible, so long as it is low risk). Often there will be one line of praise from an enthusiastic user or shopkeeper who is at Z (though often only for e-cigarettes, and he is closer to A for other tobacco products). Every so often there will be a technical acknowledgment of the benefits of nicotine. But completely missing from the institutionally sanctioned “debate” is anyone who believes that something that makes people happier overall is good, even if it makes them less healthy compared to abstinence — which is to say, anyone who truly believes in the philosophy of harm reduction.

I will come back to this.

What is more, critics say, they make smoking look alluring again, with images on billboards and television ads for the first time in decades. Dr. Glantz says that only about half the people alive today have ever seen a broadcast ad for cigarettes. “I feel like I’ve gotten into a time machine and gone back to the 1980s,” he said.

I wonder if Glantz realizes that his recall of history that he lived through is as poor as his interpretation of study results? No one has seen a television ad for cigarettes in the USA since the 1971, when they were banned (which means that well over half the population has not seen such an ad on domestic television). Perhaps Tavernise garbled his point and he was referring to cigarette billboards (though I do not recall seeing any of these for e-cigarettes), which did exist in the 1980s — but, um, also through the 1990s. I suppose “senile” is a valid alternative hypothesis to “sociopath”.

Of course, that is not the main problem with the claim. How can touting a smoke-free product that is all about anti-smoking make smoking look alluring? Those “critics” seem to never explain this, and the reporters — even when they are writing a basically solid story — do not bother to ask.

Researchers also worry that e-cigarettes could be a gateway to traditional cigarettes for young people. The devices are sold on the Internet. The liquids that make their vapor come in flavors like mango and watermelon. Celebrities smoke them: Julia Louis-Dreyfus and Leonardo DiCaprio puffed on them at the Golden Globe Awards.

I could have been charitable and skipped this paragraph, but I was so baffled about how it relates to the narrative, or even to itself from one sentence to the next, that I just had to comment. It seems to be where some leftover sentences got dumped.

Of all the reasons that entertainers are terrible role-models, their choice to vape — or for that matter, to smoke or shoot heroin — is nowhere close to the top. Also, I would have emphasized Jenny McCarthy, who claims (contrary to reality, and at great expense to society) to have expertise on public health, rather than non-political entertainers who just happen to live on camera. But since Tavernise did not actually go anywhere with this, it is hard to figure out what the point was supposed to be.

The first sentence is made substantive by the next paragraph:

A survey from the Centers for Disease Control and Prevention found that in 2012, about 10 percent of high school students said they had tried an e-cigarette, up from 5 percent in 2011. But 7 percent of those who had tried e-cigarettes said they had never smoked a traditional cigarette, prompting concern that e-cigarettes were, in fact, becoming a gateway.

As has been discussed extensively in thisblog, these statistics have been widely misinterpreted, including by the CDC itself. But this paragraph is worse than usual. Notice the switching between percent of the entire population and percent of that percentage. Most readers are going to interpret this as saying “10% had tried, and 7/10 of those had never smoked (i.e., 7% of the population had tried e-cigarettes and had never smoked)” when actually it says “a mere 7/100 of those who tried e-cigarettes had never smoked (i.e., 0.7% of the population).” Moreover, not only is the gateway claim unsubstantiated, but is not supported by this observation at all: Someone who has tried an e-cigarette and does not smoke is obviously not a gateway case.

That is not what the precautionary principle says. That phrase is used incorrectly at a rate that may even exceed the misuse of “epicenter” or “socialist”. While it is not well-defined, the actual precautionary principle basically says that we should not allow someone to inflict involuntary harms on others, particularly if the action is difficult to reverse, without first providing evidence that the harms are acceptable. For example, the burden of proof should not be on those who fear that building massive “renewable” energy facilities causes harm, defaulting to allowing it them until someone proves it they are harmful, but rather on the builders to do the research in advance to show they are not too harmful, defaulting to forbidding it until that is established. It is a reasonable standard for the environmental impact situations for which that principle was created. It is not relevant to consumer products. The consumers are making a free choice that affects only themselves, and there is nothing irreversible about it.

This illustrates how “public health” treats people as adversaries rather than the basis of concern, and how the mainstream media never calls them on it. A company that wants to site a noxious facility is in an adversarial relationship with people who might be hurt by it, and so there is a need for regulation about whether the action is allowed (as opposed to just quality control and truth in advertising rules, which are almost always appropriate) and the precautionary principle is arguably appropriate. This does not describe choices about tobacco products (or soda, food, etc.), where the decision maker and the only “victim” of consequence are the same person. This is perhaps the defining characteristic of the “public health” political faction, conflating individual choices with adversarial situations with imposed harms. (Aside: extremist “free market libertarians” make exactly the same mistake — conflating personal choices and actions that impose major external impacts — but conclude that because the former should be free, the latter should also.)

Focusing on the speaker rather than the message for a moment, here is where some knowledge about the history of THR would be useful. The CDC and those who currently control it were blatant anti-THR liars long before e-cigarettes came along. Everything they say about e-cigarettes needs to be filtered through that background knowledge. Interestingly, that is not true of Glantz, who was largely silent about THR before e-cigarettes, even as he was authoring some of the most extreme anti-smoking lies. This lends credence to the theory that he hates e-cigarettes because he genuinely believes they encourage or glamorize smoking, which he obsessively hates, or even that they just mimic it. By contrast, Siegel was aggressively anti-THR before e-cigarettes, and that contradiction is more difficult to explain.

E-cigarette skeptics have also raised concerns about nicotine addiction. But many researchers say that the nicotine by itself is not a serious health hazard. Nicotine-replacement therapies like lozenges and patches have been used for years. Some even argue that nicotine is a lot like caffeine: an addictive substance that stimulates the mind. “Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Ok, fine. But notice the non sequitur — another one that is common in the discussions and not just an artifact of Tavernise’s article. The first sentence is about addiction, but the rest are about consumption, whether there is “addiction” or not. It points out the fact that not only does “addiction” not have a real definition, but most of the time that it is used, it means nothing more than “engaging in a behavior that the speaker believes is immoral.”

Another ingredient, propylene glycol, the vapor that e-cigarettes emit — whose main alternative use is as fake smoke on concert and theater stages — is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

Um, sort of. Its most common other use as an aerosol is fake smoke — it has a zillion non-aerosolized uses. The aerosol is also used in some inhaled medicines.

Perhaps the reporter should have quoted someone with expertise on exposures other than nicotine regarding the non-nicotine aspects of the exposure. It is true that the exposure is great enough and sufficiently novel that problems might be discovered, and it is worth watching for them. But that conclusion, from someone who actually knows about exposures other than nicotine, is about keeping an eye on it, just in case, not the alarmist “are a concern” that feature story reporters prefer.

But Dr. Siegel and others contend that some public health experts, after a single-minded battle against smoking that has run for decades, are too inflexible about e-cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e-cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Therein lies a very interesting question. Is THR really all that similar to injection drug use harm reduction? And do the public health (to say nothing of the “public health”) people who support smoke-free alternatives really believe in the core values of harm reduction. Yes and no.

The adoption of the phrase “harm reduction” in the tobacco context was a conscious reference to approaches like needle exchanges for IDU. The comparison was certainly useful for getting the concept established, and I used it many times for a decade. But with the term established (and with hopes of getting institutions that support IDU harm reduction to also support THR having proved a dismal failure in spite of focused efforts by me and others — another thing that is useful to know about THR), the analogy now seems to do more harm than good.

9 responses to “A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 2)”

The key point I really like is your emphasis on the point that smoking, for a smoker, is a good. Which also carries negatives, but that doesn’t stop it being a good. The ANTZ would love to “explain this away” by claiming that any pleasure anyone gets from smoking is illusory – and make utter fools of themselves in the process, exposing themselves as religious nutcases in all but name.

I remember posting a long comment online about how much I enjoyed smoking cigarettes. I even acknowledged that smoking had its bad side too (which was why I switched to vaping), throwing the opposition a bone. Nevertheless, the reaction I got wouldn’t have been much worse if I’d written a cookery column about roasting babies for breakfast.

Feel like applying your scalpel to the Guardian (UK) article from Friday? It features our own this-side-of-the-pond star-ANTZ Martin McKee making some truly shocking statements. My favourite is his fear that “normalisation” of vaping might undermine the public’s automatic (carefully-nurtured) “Freak Out – Someone’s Smoking!” reaction, raising the Spectre of someone actually lighting up a real cigarette in a far corner of a room (far enough for smell to not be a factor) and getting away with it for at least, oh, 45 seconds, before the smoke spreads. Rather than being immediately jumped on and lynched by a volunteer militia SWAT team, as they are now (or as McKee would like them to be).

Of course, you may not want to look at another article so soon; perhaps your weekly exposure to mentally-toxic bull**** has exceeded OSHA limits already?

“But completely missing from the institutionally sanctioned “debate” is anyone who believes that something that makes people happier overall is good, even if it makes them less healthy compared to abstinence — ”

Good point, but what about the “less healthy” claim? What is absolute health? Is it only physical, or is it a combination of both mental and physical health? What about the very real physical effects of mental stress on the body (there are many apparently)? Doesn’t smoking/vaping, etc… relax a hell of a lot of people who might otherwise be running around in the rat race with no respite from the ever turning treadmill of life? What does the health establish often tell folks that are high strung? Usually one of two things: 1) Try to relax..take some time out to reflect every once in awhile.. or….2) Here, take this often dangerous drug to lower your stress, etc…I would argue, and I am sure that you agree, that the former is the better option.

Stress can cause inflammation and inflammation is often a precursor to disease…according to the numerous health studies that we have all read over the years. Isn’t is therefore possible that a user of a low risk THR product could in fact be healthier than than that of someone who is abstinent entirely?

I do confess that I am only half way through your post, so I apologize in advance if you have already addressed this issue…going to read the rest now:-)

Shouldn’t every known expert (including reporters, etc..) at this stage in the evolution of e-cigs be aware of the fact that there are 100% VG juices available? Why do they fail to mention this so often? Hmmmm…

Tobacco Harm Reduction (THR)

THR is the public health strategy of encouraging smokers to switch to low-risk alternatives like smokeless tobacco and e-cigarettes. It is the only proven method for reducing smoking below about a fifth of the population once it becomes established. (So why would anyone be anti-THR? See the "About" page.)

The continuing scourge of [smoking]-produced disease is unlikely to yield to today’s "evidence-based" interventions. (scare quotes added) Kenneth E Warner; see post if the implications are not obvious

If someone says the sky is green, you prove that it’s actually blue, and the next day he comes back once again insisting that the sky is green, and this happens repeatedly, you eventually have to acknowledge that mannerly debate about the color of the sky just isn’t enough; you have to go meta, and talk about the fact that this guy and his friends just aren’t in the business of honest discussion. Paul Krugman

He who is merciful to the cruel will become cruel to the merciful. Ancient Midrash